The Washington State Department of Labor and Industries (L&I) administers its own workers’ compensation benefits, either through a public state fund (covering two-thirds of Washington state workers) or through self-insured employers (covering one-third of Washington state workers). Essentially, L&I is a State-run insurance company that provides benefits to workers who are injured at work or develop an occupational illness.
What Is an L&I Claim?
An L&I claim is a file of important information about a worker, their injury or exposure, their specific job, and their employer. An L&I claim is monitored and managed by an L&I Claims Manager who sees the process through from initial claim filing to closure. If all goes as planned, your claim is accepted by L&I and you will receive certain benefits.
L&I, or your self-insured employer, can approve your claim if your doctor certifies that you were injured at work or have an occupational illness. If your claim is accepted by L&I, you will receive certain benefits. Some of the benefits to which you may be entitled are medical care, time-loss, vocational rehabilitation, and L&I disability pensions for the most severely injured individuals. However, due to the bureaucratic nature of the claims process, many cases get bogged down in red tape, paperwork, and technicalities.
How Does L&I Work?
When you are injured or contract certain types of illnesses at work, you are entitled to workers’ compensation benefits. You can file an L&I claim in Washington state through the L&I website’s File Fast tool, by calling the L&I office at 877.561.3453, or at your doctor’s office. After you file, it is imperative that you call an experienced L&I attorney to help you navigate the L&I claims process.
Who Is Covered by L&I?
Virtually all employees in Washington state are covered by L&I workers’ compensation insurance. Two-thirds of Washington state workers are entitled to workers’ comp benefits through L&I. The remaining one-third of workers file claims directly through their self-insured employers. To determine whether you are covered by L&I or a self-insured employer, use the Find A Self-Insured Employer search tool on the L&I website.
Claim Value
To determine the value of your L&I settlement or award, you first need to understand the different types of workers’ compensation offered in Washington state. L&I settlements and awards are paid out once the claim is closed, though the total settlement or award amount paid upon claim closure depends on the claim itself. L&I settlement and award amounts vary widely and typically fall into three categories:
1. L&I disability pension: A life-long benefit awarded to injured workers who will never be able to return to any gainful employment due to a severe or life-threatening injury.
2. Permanent partial disability (PPD) award: A one-time sum paid to injured workers when their L&I claim is closed. The worker can re-enter the workforce following a PPD award.
3. Claim resolution settlement agreement (CRSA): An L&I settlement option where all parties agree to close an injury claim for a specified amount. When agreeing to this settlement type, the injured worker exchanges all future benefits, except medical, for the payment.
How to File an L&I Claim in Washington State
In order to receive benefits from L&I there are two very important things that you must do right away, even before a claim is filed:
- Get medical help.
- Tell your employer.
If you are injured at work, you have three options to file a Washington state L&I claim:
- File by phone at 877.561.3453.
- File online through the L&I website’s File Fast tool.
- File at your doctor’s office.
Note that if you work with a self-insured employer (SIE), you must file your claim with them. Contact your employer’s human resources department for help.
To file an L&I claim in Washington state, you must provide the following:
- The location where the injury occurred
- Contact information for any witnesses to the injury
- Employer information
- Wage information
- If you have already seen a doctor:
- Your doctor’s first and last name
- The hospital or clinic where you received treatment
If you are eligible for time-loss and no further information is needed, L&I or your self-insured employer will send the first benefit check within 7 days of receiving the report. If your doctor is one of the many healthcare providers that do not handle workers’ compensation claim cases, you can find an L&I-approved doctor on the L&I website. If your L&I claim is approved, the State will cover the initial visit even if it wasn’t with one of their approved doctors.
L&I or your self-insured employer must receive your Report of Accident within 1 year of your injury date to file a claim. Occupational illness claims must be received within two years of the date that your doctor notified you in writing that your injury is work-related.
HOW IT WORKS
Watch This Video to Learn More about the Workers’ Comp Claim Process
Common Claim Mistakes
L&I claim mistakes happen all too often. Some of the most common mistakes are the following:
If you want the best chance of receiving the L&I benefits to which you are entitled, you need to report your injury and start the L&I claim process right away. You have one year from the date of your injury to file a claim for L&I benefits, or two years if the injury is an occupational illness. If you miss these deadlines, it’s very likely your claim will be permanently barred by these statutes of limitation.
L&I or your self-insured employer (SIE) may require that you seek an Independent Medical Exam (IME) from an approved L&I provider who can validate your injury and provide a neutral second opinion on your condition. The purpose of an IME is to help the insurance company determine the reality and extent of your injury. The L&I doctor’s findings are then used to deny or award benefits for your workers’ compensation claim to help you recover and pay for treatment. Visit our page about how to beat an IME exam and learn how you can see past IME doctor tricks.
One common Labor and Industries claim mistake workers make is downplaying their injuries when they first see a doctor. However, if you don’t tell the doctor exactly what you are experiencing, the doctor’s records won’t reflect your injuries and pain, and L&I or your employer could use these records to later prove that:
- Your injuries and pain are less severe.
- You weren’t really injured at all.
- Your injuries are the result of something that happened outside of the workplace.
There are always risks associated with talking to a doctor for an L&I claim. However, you’ll avoid making some of the most common L&I claim mistakes if you’re honest about your injuries and the impact they’ve had on your life.
In most circumstances, you should not outright refuse an offer for light-duty work. You may find that you can cope with light-duty work if it’s pitched at an appropriate level. If you find yourself in this situation, the first thing you should do is call Emery | Reddy to speak to an experienced Intake Specialist to learn about how we may be able to help you with your claim. The second thing you should do is contact your doctor. If your doctor disagrees with the light-duty job in writing, you will have a good argument to L&I that you remain unable to work; if you hire an experienced L&I attorney, they can help you craft that argument and ensure that you get the proper time you need to heal.
Don’t make the common L&I claim mistake of waiting too long to protest or appeal your claim. You, your employer, and your doctor all have the right to protest any decision made about your claim. The Department of Labor and Industries or your self-insured employer (SIE) must receive a written protest within 60 calendar days of the date the decision was received (15 days for decisions about vocational benefits) or the decision becomes final. You may also appeal directly to the Board of Industrial Insurance Appeals (BIIA). The decision becomes final if your written appeal is not received within the following legal time limits from the date you received the decision:
- 60 days to appeal a claim decision or a payment decision
- 20 days for providers to appeal a billing decision that reduces the amount paid or demands repayment
- Who issued the rating?
- Did the Independent Medical Examiner provide the rating?
- Which doctors support the rating?
It is important that you have the right medical opinion and support to ensure that you receive the highest rating available.
Construction Site Claims
Much of what happens on a construction site has the potential to cause bodily and mental harm should something go wrong, with injuries occurring at a higher-than-average rate for construction workers due to the following factors as stated by L&I:
Heavy Lifting or Overexertion
Working at Heights
Confined Spaces
Hazardous Chemicals and Materials
Heavy Machinery and Power Tools
Flying Debris and Falling Objects
Harsh Weather (e.g., Heat, Cold, Wind)
Slip-and-Falls
HOW IT WORKS
Watch This Video to Learn More about How Employment Law and L&I Claims Work Together
Your L&I Claim Is Worth More If You Also Have an Employment Claim
A significant number of L&I — workers’ compensation claims often involve additional legal claims such as employment or third-party claims. Many people file their claims without seeking representation from an L&I attorney and thus never discover that, in addition to their L&I claim, they may be missing out on the ability to file an employment claim or a third-party claim. Pursuing additional legal action with the help of an experienced Labor and Industries attorney has the potential to significantly increase a claim’s overall compensation. At Emery | Reddy, PLLC, our experienced Attorneys practice both Employment and Workers’ Compensation Law, which means we will investigate all aspects of your claim to make sure you aren’t missing out on any potential benefits.
What Is an Employment Claim?
Many injured workers find that their employer has taken, or plans to take, adverse action against them because they filed an L&I claim or they are out of work. You can file a lawsuit against your employer for several reasons, including retaliation, wrongful termination, disability discrimination, or unpaid wages. An L&I attorney who is experienced in both L&I — Workers’ Compensation Law and Employment Law can help you with your L&I claim while simultaneously filing a federal or state law claim for the violation of workers’ rights by your employer.
What Is a Third-Party Claim?
A third-party claim is one in which someone other than your employer or co-worker is responsible for your injury. If you have been injured on the job due to someone else’s actions or negligence, you may be entitled to additional compensation through a third-party claim, which combines your L&I claim with a personal injury claim using the same facts.
Unlike workers’ compensation payments, there is no limit to the amount of compensation an injured worker may seek in third-party damages. Third-party claims are private matters and are typically litigated directly with the Washington State Superior Court.
Denied Claims
An L&I claim could be denied for almost any reason including the following:
- The injury is considered preexisting and was not worsened by work conditions or an industrial accident.
- The injury is determined to have occurred outside of work.
- The injury occurred in a parking lot, which means it is not covered.
- The injury is a mental health condition and is denied due to a lack of objective medical evidence.
- An Independent Medical Exam (IME) diagnosis that determines the injury is not as bad as claimed, or non-existent.
Reopening a Claim
If your workplace injury or occupational illness worsens, you and your doctor may apply to reopen your claim. There must be medical evidence from an L&I-approved provider stating that after your claim closed, the condition caused by the original workplace injury worsened and needs more medical attention.
The amount of time that you have to reopen your L&I claim depends on the benefits you are seeking:
- For medical treatment only, you may apply at any time.
- For both wage replacement benefits and medical treatment, apply within 7 years of the date your claim was first closed (10 years for eye injuries).
- If your claim has been closed for more than 7 years, you may apply for medical benefits. However, only the L&I Director may grant additional disability benefits such as wage replacement or disability awards for these claims.
Self-Insured Employer Claims
Self-insured employers (SIEs) account for one-third of workers’ compensation in Washington state, and they provide benefits directly to injured workers. Self-insurance is less common than L&I insurance, but it’s quite popular among larger corporations, as self-insured policies allow the company to save money.
Third-Party Claims
If injured by a third party in Washington state, workers cannot sue their employer for compensation. However, when injuries are caused by defective products or machinery, or by someone who is not a co-worker, you may be able to file a third-party claim to cover the costs of your injury.
What Is a Third-Party Claim?
A third-party claim is one in which someone other than your employer or co-worker is responsible for your injury. If you have been injured on the job due to someone else’s actions or negligence, you may be entitled to additional compensation through a third-party claim, which combines your L&I claim with a personal injury claim using the same facts.
Unlike workers’ compensation payments, there is no limit to the amount of compensation an injured worker may seek in third-party damages. Third-party claims are private matters and are typically litigated directly with the Washington State Superior Court.
Who Is at Fault for a Workplace Injury?
L&I is a no-fault system, ensuring compensation for any workplace injury. However, if a third party is involved in causing the injury, you may be able to pursue legal action against them for additional compensation under third-party claims.
Closing Your L&I Claim
Your L&I claim closes when a physician certifies that further treatment will not improve your condition, meaning that you have met maximum medical improvement (MMI) or you have returned to work, or that L&I has determined that you are fit to return to work.
What Happens after Your L&I Claim is Closed?
- If you do not protest or appeal, after 60 days the closing order becomes final.
- If you protest or appeal, then the closing order is held in abeyance.
How Do I Know If I Have a Strong L&I Claim?
If you have an L&I claim or wonder if you need the assistance of an experienced L&I — workers’ compensation attorney, ask yourself the following:
- Have I been denied the medical care benefits to which I am legally entitled?
- Has L&I asked me to undergo an Independent Medical Exam (IME)?
- Do I have questions about the L&I claim process?
If any of the above apply to you, Emery | Reddy may be able to help.
Navigating a workers’ compensation claim can be difficult and very time-consuming, especially when you’re ill or injured. You want to focus on healing and make sure your bills are paid, but if you don’t file things properly or on time, your health, home, and job could be in jeopardy. Many individuals miss out on much-needed L&I benefits because they don’t understand what to do or how to get the most compensation for their injuries. If you are experiencing any challenges in your case, a Labor and Industries attorney can assist you. By contacting Emery | Reddy as soon as possible after you’ve been injured, we can help you avoid the common pitfalls of filing and navigating an L&I claim. Our Seattle L&I Attorneys are here for you every step of the way.
Emery | Reddy Can Help You with Your L&I Claim
Emery | Reddy is the only law firm in Washington state that is equipped to provide comprehensive representation on your case from every angle. Our Seattle L&I Attorneys thoroughly assess every case to determine if our clients have additional claims, and at times this can extend far beyond the underlying workers’ compensation claim.
If you have been injured in the workplace, call Emery | Reddy today for a Free Case Review with an experienced Intake Specialist to learn more about how we may be able help you.
Want More Information?
Laws regarding personal injury and insurance are extremely complex. Find out the answers to your personal injury questions today.
The Labor and Industries claim process is anything but straightforward. Find out the answers to your L&I — workers’ comp questions today.
To determine the value of your L&I claim, you first need to understand the different types of L&I awards offered in Washington state.
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Meet the Team
The L&I Attorneys at Emery | Reddy, PLLC are passionate about helping workers with L&I claims and Employment Law issues. We Help Workers®. It’s our motto and what drives us every day.
We know how L&I and big companies think, and we understand the tactics they use. Our Labor and Industries Attorneys use that knowledge coupled with over three decades of experience to help our clients get access to the L&I benefits to which they are legally entitled and hold employers accountable when they break the law.
If you’re struggling with an L&I claim, injury, or legal issue at work, call us for a Free Case Review with an experienced Intake Specialist to learn more about how Emery | Reddy may be able to help you today.
“My husband has been struggling with getting the medical attention that he needs and has been entitled to. Emery | Reddy has given us hope again.”
— Shelley M.
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